I was recommended a visit to John by a colleague after living with a knee injury for the past 2 years. John and I are currently working towards getting me back running which is something I have really missed since my injury. In my first 3 sessions, John has taken a really holistic approach to my injury and has identified different links and factors that haven’t been highlighted to me before, but which make a lot of sense. Now we are working on the way I sit and stand in normal life (which leaves a lot to be desired especially as my job is largely desk based) as a starting point to work towards running. I’m not having to do loads of exercises every day but rather I am trying to think about and be aware of how I’m holding myself (or try not to think too much as this seems to be the problem!) and to re-programme old habits. I have booked a 10k race in October so this is what we are working towards, fingers crossed!
I have always struggled with my knees, when I was a child I experienced pain and they felt like they twisted when I ran; that along with being an over weight child I tended to avoid exercise. When I got older I went travelling for 6 months and spent a large amount of that time wearing just flip flops and carrying a heavy bag most days as I moved around; once I returned to England I found that my knees had got considerably worse, they would click and crack when climbing stairs and cycling (it would make me feel sick hearing and feeling it), and when bending or kneeling down my knees would get stuck and I wouldn’t be able to stand back up again.
This all lead me to requesting assistance from an NHS Physio, she didn’t take a lot of time treating me, she just set me exercises to do, and based on my pain and thoughts of the exercises she changed her thoughts about my injury each week. It when from an old hamstring injury, to a flabby core, to you’re overweight and this is why you’re experiencing pain. at 13 & a half stone I wasn’t hugely overweight, but there was definite room for improvement. So after seeing no improvement in my knees and worsening pain in my hips, I felt that I was not getting any benefits from seeing this Physio and I never returned to her. After losing 3 and a half stone I felt great, but my knees had not improved, while training for my first half marathon I was experiencing pain and swelling as well as not being able to bend my knees to climb stairs after long runs – which at 28 should not be hard thing to do. While in the running shop asking about knee supports the guys in there recommended that I have a session with their in house Physio, so I thought why not. After an initial consultation I thought lets give a few sessions a go and see how I feel.
During my first 45 minute session with John, I saw a massive improvement in my movement and reduction in pain when being stretched in different ways, I was so shocked and couldn’t believe that it was that quick at getting results. We ran through some movements to see what my body did and reacted, then we manipulated my back and cracked it a bit, then my leg and hip was in a much better place flexibility wise. John set me an exercise called Neural Flossing to help increase the movement in my legs (stretch them out), as well as dynamic sitting to support my back and core when sitting at my desk all day.
After 1 week of dynamic sitting, at first it was weird and my back would sometimes go into a spasm, however as the week went on I found I was sitting correctly without even thinking about it. I went from pain and trying to crack my back 3/4 times a day to not at all. I even think about it when I am standing still or walking, and I feel much better inside for it.
Roll on session number 2 to see what further improvements can be had!
‘I suffered a severely fractured Calaneum (heel) bone during a stag do in Berlin in the summer of 2014. It resulted in open reductive surgery where a plate and screws were fitted and I was unable to weight bear for 3 months.
Once able to weight bear I was limping and in quite a lot of discomfort. I would get easily fatigued after periods of standing and after a day on my feet at work would need to spend the entire evening recovering. If I did socialise out after work I would pay for it the following day or sometimes days with further stiffness and pain.
I received hydrotherapy and physiotherapy sessions soon after fully weight bearing and although this helped to a degree it was still painful to walk. I still had a limp, some days were worse than others and I got to a stage where my physiotherapist expressed doubt about his ability to help me any further as I was unable to perform a heel raise on the one foot, usually doable by this stage.
John was recommended to me by a work colleague who had had a running injury. I was feeling mentally defeated at this point as it had been a year since my injury and I still couldn’t walk without some degree of discomfort. I had recently been to a wedding reception after a day at work and as a result the 2 weeks that followed had been more uncomfortable than usual. I was having severe doubts about ever being able to walk properly again.
After explaining my situation to John he worked the surrounding areas of my foot and manipulated areas in my back. I physically saw a change in my flexibility between the beginning and end of this first session. I could now move my right foot back as far as my left which I was unable to do before and it was noticeably easier walking up and down hills as I didn’t have this flexibility before. I’m now also able to perform a heel raise on the right foot and can hold this position for around 30 seconds. My confidence has improved considerably and I’m optimistic that I may even be able to resume more physical activities in the near future.’
KNEE CAUSE AND EFFECT
I returned to John for my third physio session this week and we continued to explore the causes and effects of my postural imbalance.
In the week I had been returning to the gym and found that, whilst there have been dramatic and notable improvements in my squat, which had been fairly reduced before, I was still having difficulty at the very extremes of my movement. I found that, when rowing for example, I was able to achieve a very “tucked up’ position only after easing my knee into the posture over a period of about 30 seconds.
ON YER BIKE!
I had also been biking, partly on John’s recommendation, as this allows fluid to flow around the knee and promotes recovery. I am finding cycling to be fine, with no real discomfort except upon extreme hills – which I am still avoiding for this reason. Occasionally I experience stiffness the next day but this is only equivalent to what I experience when sat stationary for an hour or two.
Once again John performed some manipulations, this time on my neck. This was both an alarming and enjoyable procedure; I’ve never heard my neck make so many cracks before, yet I felt as though a lot of built up tension had been released. This too had a remarkable and instantaneous effect upon my flexibility.
Towards the end of the session we practised walking and running. It seems that, due to the muscular imbalance in my body, I over-rely upon my IT band for walking and thus my hip rotates forwards. I was shown how to become aware of this and told to practise on an ergo-rower, treadmill or when walking and running.
I first came to see John three weeks ago after damaging my knee. The injury was caused, about a fortnight beforehand, by performing the (slightly ridiculous) task of standing up with a friend on my shoulders whilst on the side of a fairly steep slope; as I stood up I felt something lock and, as soon as I had put my friend back onto the floor, I felt a painful ‘ping’ inside my knee.
The day after I had sustained my injury I could barely walk, I limped up and down stairs and generally avoided putting any weight onto the leg. The knee had swollen and was fairly painful to the touch, causing movements or weight-bearing to be difficult. Thankfully, at first, the swelling seemed to reduce with each passing day and the pain involved in using the joint subsided with it. This lasted for around a week at which point my recovery seemed to stall and I contacted John.
My first physio session was mainly focused on determining the cause of the pain and swelling: John spent a long time testing my flexibility and movement range, along with probing my knee for ligament damage. He said that, at first, he had suspected my ACL had been damaged due to the injury being caused whilst facing downhill on a slope, luckily this was not the case. By the end of the session John believe the cause was likely to be a twisting within the kneecap caused by muscle imbalance that had caused the fat pad to become upset and possibly to catch.
We ended the session by discussing “dynamic sitting”, a method of adjusting seated posture to relieve muscle tightness and fatigue that will hopefully correct my postural imbalances. I feel that this is particularly important to me as my job involves a large degree of “screen time”.
During my second session with John we continued to discuss my postural imbalances and to try and work through some of their causes, along with trying to mitigate against their effects. We worked through some tests to determine neural strength and found that, in many places, the muscle on the left side of my body had decreased mobility with respect to the right: particularly those associated with the L5 nerve root. John performed some manipulations on my back that seemed to immediately have a positive effect on these areas – I was able to raise my left leg an additional 10° from my attempt before the manipulation!
At the end of my second session we discussed dynamic sitting some more. I have now purchased a standalone keyboard and mouse that I am using to correct my posture whilst at a computer and it seems to be having a positive effect. We also discusses ” neural flossing ” and John set me some homework to investigate and try this.
Here is an update on how I’ve been getting on since my last treatment session with you back in December. I’ve delayed sending this as I wanted to include an update of the Highlander Mountain Marathon.
When I came to Physio in December I had been suffering with a strained adductor muscle (since August) and recurrent problems with my calf and ankle muscles which you’d diagnosed were caused by poor upper body posture from working at a laptop all day. I was keen to get these problems sorted out so I could be fit enough to start training in earnest in the New Year for the Highlander Mountain Marathon at the end of April. My training runs prior to seeing you had been very irregular, at the most consisting of a long weekend run and one other 10k run per week.
Your physio sessions got me back running again and the advice you gave me about my posture and running form chimed with advice I’d been given by Susie Baker, my Alexander Technique teacher, in the past.
New leaf in 2015
I decided to turn over a new leaf in 2015 and set myself a target of running or walking at least 5km every day. I’m pleased to say this is something that I am still doing and I usually only have a walking instead of running day once a fortnight or so.
Running every day
Contrary to fears that running every day was going to exacerbate the calf and ankle problems I had been suffering with, I found that the aches and pains lessened and then disappeared completely. Running every day gave me the opportunity to concentrate on my posture more and to practice running with good form. Knowing that I have to do 5km every day means that as soon as I get any pains or niggles I treat them straight away with either stretching, wobble board or foam roller as appropriate. I have even had a couple of sports massages from Katherine Golik to treat tired legs. I’m going to continue with running every day for the foreseeable future: I’m used to it now and it’s become a habit. The only thing I would add is more core exercises to enable me to maintain good form over longer distances.
Highlander Mountain Marathon and Butcombe Trail
As well as the Highlander Mountain Marathon in April (running 32 miles with 3,890m of ascent over a weekend with a backpack containing food, clothes, sleeping bag and tent), I ran the length of the Butcombe Trail during one long day in March: an unsupported solo run of 48 miles in 11 hours (which included time for map reading and stopping in several pubs on the way round for tea, coffee and extra water).
Man v Horse marathon
My next challenge is the Man v Horse marathon in June followed by a 50+ mile ultra in September.
OUCH! HIP PAIN
Week two of not being able to run and after a pain-filled weekend trying to juggle a two year old who refuses to walk down the stairs, I hastily book a second appointment with John at his AAA-Physio Clinic in Bristol BS8. As I hobble (very much a left leg limp) the short distance from my office to Moti, I am aware that every step is pinching my left hip and is a struggle.
And so the debrief, I have managed to spin and row in the week since I first saw John, but the pain I’m experiencing hasn’t eased at all. In fact, if anything it’s much worse. Carrying said two-year-old halfway across the Downs to the circus certainly didn’t help.
I’ve been to the doctors (usual anti-inflammatory prescription and inconclusive x-ray) to no avail and am told it could be six weeks before I can run again…
After a brief look at the extension on my left hip (or lack of it) John sets to work on my back. I’m shocked at how painful my lower back is. Ten years post-surgery, I am somewhat used to niggling there but as John works his way around my lower spine, I feel sharp shooting pains that actually make me scream. And so, the initial diagnosis is reiterated. In my inability to stabilise my core, I’m causing myself all kinds of problems in my neck, arms and, most painfully, my hip.
BACK TO RUNNING
I think it’s going to be a slow road back to stability and running, but leaving the clinic, into the driving Bristol rain, I’m already feeling a bit stronger and if I really put my mind to it, can see how strong core (deep breath in relax into the stomach) does help ease the pain. Another challenge…and one I’m determined to win.
These drills from The Running School (R) , have great potential for improving the trunk and lower limb strength and stability in a range of age groups.
I can see this style of exercise being particulary effective and engaging for teenagers. JS Physio MSc
Bristol Physio John Stephenson has been providing movement retraining courses for Health Professionals & Physiotherapists since 1999. He also works on a 1:1 basis with private clients wishing to improve their low back stability and running efficiency. Or for a more gentle introduction, ask about the Walk:BacK & Row:BacK programmes!
Book a consultation or free minute open clinic online:
Problem – I think I do a good level of exercise, 3-4 hours a week, often including 10-15 miles (running) off-road, I also do circuits at least once a week, in the hope that it will keep the body in shape, and that I can keep up with the kids and defeat ageing, while enjoying the countryside west of Bristol.
However, every couple of years the body rebels and all sorts of random parts of the body rebel. Back – Knees – Ankle – Neck
Treatment – ring John @AAA-Physio and get myself booked in. Somehow he identifies which bits of my back are the root cause and tells me I don’t sit properly at my desk. He also finds aches I didn’t know I had. A few crunches and 24 hours of thinking not much has changed… ..the old body is revived!
1) I really should stretch more often & use free the exercise sheets on John’s website
2) I shouldn’t wait till my backs ceases up or a muscle locks up before seeing John
3) Chasing balls is for dogs and not middle aged men!